Both hyperlipidemia and hypertension are complications of chronic renal failure and hemodialysis which frequently persists despite successful rental transplantation; reports of precocious artherosclerosis in chronic renal failure patients treated with either modality are accumulating. We aim to determine whether an alternate-day corticosteroid regimen reduces the prevalence of these two atherogenic risk factors in comparison with a daily regimen as suggested by our retrospective studies. We will continue to describe plasma lipids in renal transplant candidates and, after successful transplantation, randomly allocate these patients to either a daily or an alernate-day corticosteroid regimen. Plasma lipids and blood pressure will be studied when maintenance immunosuppression is achieved. We have demonstrated that corticosteroid dose spacing has no effect on blood pressure or plasma lipids in patients who are normal at the onset. To determine the specific effect of corticosteroid dose spacing in abnormal patients, plasma lipids and blood pressure will be serially studied in a separate group of stable hypertensive, hyperlipidemic, renal transplant recipients currently on alternate-day steroids during 6 months of a daily regimen and again during reinstitution of alternate-day therapy. To identify the factor(s) which might explain the low prevalence of hyperlipidemia in our patients, we propose to survey plasma lipids in all of our patients, and correlate these with cumulative and maintenance steroid dose, time since transplant, obesity, renal function, and carbohydrate intolerance. These studies will demonstrate the effect of corticosteroid dose scheduling on two important atherogenic risk factors and may offer important therapeutic alternatives to patients receiving chronic corticosteroid therapy.